Personal Care at Home Bill

I shall speak to Amendments 37 and 42, which stand in my name. I am pleased, as always, to follow the noble Baroness, Lady Greengross. It is fitting that I, too, want to talk about people with dementia and the importance of having staff who are trained and who understand the nature of dementia in the delivery of services. I used to have an office whose window looked across the street. Twice a week, a little van would turn up from social services. A lady would get out and ring the door of a house that was divided into flats. She would wait for quite a while while the gentleman inside came to answer. All the time, she would continue to talk to the driver of the van. When the gentleman came to the door, she would hand him his package of dinner while continuing to talk to the driver. She would then turn around and walk away. That gentleman had dementia. She did not even know whether he ate that dinner, fed it to his dog or threw it in the bin. She had no idea of what his life was like inside his house. It was the absolute epitome of a service being delivered so badly and so wrongly for somebody who had dementia. I would hope that that sort of thing would not be so common these days, but who knows? Hard-pressed staff might find themselves in a similar position. I wanted to table the amendment because it is important that we remind ourselves that we are talking in this Bill about two very distinct groups of people. There are adults with disabilities who for the most part will have conditions which are life-long and stable. Their needs may change, but probably not much over time. We are talking also about older people whose conditions can change quite rapidly, and older people whose conditions might be limiting and long-term, and change gradually. Their needs are very different. I hesitate to say it in front of the noble Baroness, Lady Murphy, but, in lay terms, the needs of people with dementia can change. The noble Earl, Lord Howe, was absolutely right: the distinction between substantial need and critical need is very difficult to determine, particularly when people have fluctuating needs. When speaking to an earlier group of amendments, I asked the Minister how many of the FACS-critical criteria one would have to meet. Those criteria include: """Life is, or will be, threatened"." That is a comparatively easy thing for a member of staff or an assessor to find out. However, there is also the criterion that: ""There is, or will be, an inability to carry out vital personal care or domestic routines"." Is that so clear and easy to determine, and are the consequences of it so great? Therefore, I tabled this amendment and Amendment 42, which is similar to that of the noble Earl, Lord Howe, to determine exactly what is meant by personal care. There is, as noble Lords are aware, no definition of personal care in primary legislation in England. As several noble Lords have already spotted, the definition in this amendment is the definition in the Scottish legislation from the Community Care and Health (Scotland) Act 2002, as amended in 2009. The significant amendment in 2009 was the consideration of the preparation of food. When looking at an amendment such as this, it is perhaps very easy to dismiss as insignificant each individual sub-clause of each individual part. However, in terms of the life of a person who is likely to be eligible for free personal care—and for their carers—each and every one of these small things is an extremely important part of life. The Government have always resisted having a definition of personal care in primary legislation, and I am sure that they will do so now. I would be staggered if they did not. However, one of the excuses that they have always run in the past is that putting a definition into primary legislation would by its very nature be exclusive and would probably be unworkable. In Scotland, however, that has proven not to be the case; it has proven that the lawyers, sadly, have not made that much money from bringing cases to contend what is meant by an unclear definition. I also wish to echo the points made by the noble Earl, Lord Howe, that the definitions proposed in the Bill and in the regulations do not equate to the six basic categories of activities of daily living. That is pretty well bound to cause confusion, if one is not being too generous. As I did at Second Reading, I echo the point made by the noble Earl, Lord Howe. Help with the provision of medication is a critical part of life for these people, and it therefore seems to me that it is a major omission. The prompting and supervision of people who have dementia to do some of the personal care tasks of which they are capable but which they cannot do if they are not prompted seems to me to be a critical part of this. I echo the point made by the noble Baroness, Lady Greengross, that prompting somebody to do that must be one of the areas of personal care.